The tortuous route for doctors to prescribe medical cannabis in New Zealand

By Barbara Docherty

Not many GPs seem to be prescribing medicinal cannabis, not for now at least. Cannabis for medicinal use is being taken more seriously but many health professionals prefer to shy away.

This may well be because evidence as to efficacy is mixed, even though anecdotally many patients have compelling stories about its pain-relieving qualities and other properties.

The evidence landscape currently shows that the scientific and clinical studies to support medical use of cannabis and cannabis-derived products is still limited with very little in-depth research using different cannabis products at different doses or as comparative studies for the treatment of chronic pain.

Pain management specialists currently seem to still favour traditional pain management over cannabis. Yet increasingly, examples of standard therapies for notoriously difficult-to-treat symptoms are showing cannabis to have compelling signs of usefulness.

To date, there have been few applications and ministerial approval has been granted for only a small number of patients.

Lack of familiarity causes hesitancy

Understandably, many doctors remain hesitant to recommend cannabis for lack of evidence or being unfamiliar with the medical uses of cannabis and fear about getting into trouble. I am sure no one is quite ready to be called “the weed doctor”.

But while we’d all like to think that healthcare professionals are open minded on the possible benefits rather than prejudicially smitten, it’s no secret that GPs and primary healthcare nurses avoid discussing the subject of cannabis, sometimes because of conservative views or due to personal prejudices about the loser who smokes pot.

Not part of the discussion in general practice

While it is acceptable to interrogate patients about their tobacco smoking the other kind of smoking is rarely part of a general practice conversation.

Associate minister of health Peter Dunne has stated he would be concerned if doctors’ personal views about cannabis were causing them not to seek approval for medical cannabis products for patients where it might be useful.

But it’s also true that nurses and GPs often simply feel out of their depth, and more clarity and education for health professionals is required due to the complicated nature of this plant and its 500 natural compounds, up to 80 classed “cannabinoids”.

Public pressure mounts

Current research has looked closely at methods of cannabis-based medicine administration such as sprays, tablets and extraction methods including vaporisation, so that users can avoid the harmful effects of smoking. But we urgently need to understand the law and feel more comfortable about prescribing.

Either way our attitudes and behaviour will have to change as pressure mounts daily for cannabis use for medicinal purposes. This also means that health professionals have to feel comfortable that prescribing cannabis does not a sinner make.

A nun's story

There may be some reassurance in knowing that the supposed first sinner in New Zealand to grow and use cannabis for medicinal purposes was none other than someone well on her way to official sainthood. Suzanne Aubert, known as Mother Mary Aubert, who lived from 1835 to 1926, has just been declared "venerable" ("heroic in virtue") by Pope Francis.

No wonder many are trying to blindside her wonderful nursing work in Jerusalem on the Whanganui River because much of the local income came through the sales of Aubert's medicinal formulations. According to legend, these included many cannabis-based medicines such as early use of “Indian hemp” used in asthma cigarettes, for recovering alcoholics, corn cures, cough mixtures and easing menstrual pains.

Doctors in New Zealand can now legally prescribe medical cannabis by going through a ministerial approval process which includes three different types of medical cannabis products usually of pharmaceutical grade and using different criteria.

A 2006 study showed diabetic improvement in non-obese mice with CBD (cannabidiol) only, omitting the cannabinoid THC that creates the “high”. There are other research projects showing signs of promise.

It's only three hours away

Recent changes to Australian legislation allowing for the possibility that just a three-hour flight away plus a supposed loophole which allows being able to legally bring back to New Zealand legally prescribed cannabis medication, is yet another reason why more acceptability of medical cannabis will inevitably occur here in New Zealand.

My only experience in this regard is one of my terminally ill patients who showed sudden signs of much reduced pain and we all wondered if he was miraculously cured until he revealed his use of cannabis spray.

I have no idea how he got it and he had no intention of revealing his sources. He died an almost pain-free death with a smile on his face and his continual quote “Cannabis is the healing of a nation, alcohol is the destruction”.

Unfortunately Mother Aubert apparently took her cannabis recipes to the grave with her. Pity. She could have passed them onto nurse practitioners and registered nurses with prescribing rights who would probably happily have carried on her good work but nevertheless be classed as sinners until legislation allows them to legitimately prescribe medicinal cannabis.

- NZ Doctor